颈部胸导管引流对重症急性胰腺炎并发急性肺损伤早期干预的影响

Effect of thoracic duct ligation/conduction in rats with severe acute pancreatitis accompanied with acute lung injury

目的观察颈部胸导管结扎／引流对重症急性胰腺炎（SAP）并发急性肺损伤（ALI）早期十预的影响。方法5％牛磺胆酸钠逆行胰胆管内注射制大鼠SAP并ALI模型，分为似手术组（S0）、胰腺炎组（SAP）、胸导管结扎组（LC）、胸导管引流组（DC），观察胸导管结扎／引流在SAP并发ALI时对肺脏组织病理形态、超微结构、动脉血PaO2和PaCO2的影响，以Westernblot法检测生存素（Survivin）的表达。结果SAP、LC、DC各组肺脏的病理评分均随时间延长上升；透射电镜下SAP组、LC组肺泡表面Ⅱ型细胞变化较重，DC组病变较轻；与同时点SO组比较，所有ALI模型组2、6h的Pa02均明显升高（P〈0．05），12h的PaO，均明显降低（P〈0．01）；ALI模型组2、6h的PaCO3明显降低（P〈0．05），12h的PaCO2明显升高（P〈0．01），颈部胸导管结扎或引流能改善上述指标，且DC组优于LC组；2h时仅SAP组Survivin表达（1．278±0．172）高于SO组（0．568±0．077）（P〈0．05），其余各组间差异无统计学意义（P〉0．05），12h时Lc组（0．624±0．084）、DC组（0．282±0．038）表达较SAP组（1．074±0．145）明显降低，以DC组降低更为明显（P〈0．05）。结论在SAP时胸导管结扎／引流可以减轻继发的肺损害；引流胸导管的效果优于结扎。

Objective To investigate the effects of thoracic duct ligation/conduction in rats with severe acute panertitis （SAP） accompanied with acute lung injury （ALI）. Methods Models of SAP ac- companied with ALI were made through retrograding injection into biliopancreatic duct by 5% sodium tau- rocholate, then thoracic duct was conducted or ligated after separation. Effects of different operations on lung ultrastrueture,lung pathogenesis score, blood gas and the expression of Survivin were tested. Results As compared with SO group at the same time point, lung pathogenesis score was increased significantly in SAP, LC and DC groups （P 〈 0. 01 ）. Alveolar type ]I cells changed more obviously in SAP and LC groups than in DC groups under the transnfission electron microscopy （TEM）. As compared with SO group at the same time point, PaO2 in subgroups of SAP 2 h and SAP 6 h was also increased significantly （ all P 〈 0. 01 ） , PaO2 in subgroup SAP 2 h was obviously higher than in subgroup of SAP 6 h （ all P 〈 0. 01 ） , and PaO2 in subgroup of SAP 12 h was obviously higher than in subgroup of SO 12 h （P 〈0.01 ）. As com- pared with SO group at the same time point, PaCO2 in subgroups of SAP 2 h and SAP 6 h was decreased sig- nificantly （P 〈0. 01 ）, and PaCO2 in subgroup of SAP 12 h was obviously higher than in subgroup of SO 12 h （P 〈 0. 01 ）. The effects of conduction were more satisfactory than those of ligation. The expression of Sur- vivin was stronger in SAP group （1.278 ＋0. 172） than in SO group （0.568 ＋0.077） （P〈0.05） at 2 h. The expression of Survivin in LC group （0. 624 ＋ 0. 084 ） and DC group （0. 282 ＋ 0. 038 ） was weaker than that in SAP group （ 1. 074 ＋ 0. 145） at 12 h （ both P 〈 0. 05）, and th expression of Sin-alvin in DC group was decreased more obviously. Conclusion Thoracic duct figation or conduction could decrease the pathological changes in rats with SAP, and the effect of conduction was more satisfactory than that of ligation.